As we work together to stop the spread of COVID-19 at home, work and in the community, we want to make sure you have the resources you need to keep informed, healthy and safe. If you have any questions about OHP and COVID-19, please let us know.
Updates for Oregon Health Plan providers
Help Oregon complete Phase 1a of the COVID-19 Vaccine Sequencing Plan: The Oregon Health Authority (OHA) encourages all health care personnel working in settings identified in Oregon's Phase 1a Vaccine Sequencing Plan to get their COVID-19 vaccination as soon as possible. Please read the announcement from OHA to learn more about:
- Eligible settings and personnel in Phase 1a;
- Where to find information about getting a vaccine near you; and
- Where to find the latest information about Oregon's vaccine sequencing plan.
OHP pharmacies can now bill fee-for-service (FFS) COVID-19 vaccine administrations through point of sale: Please read OHA's Feb. 5, 2021 fax to Oregon pharmacies for billing and reimbursement details. This applies to vaccine administrations that:
- Are delivered to CAWEM members and Oregon Health Plan (OHP) members;
- Are pharmacist-ordered and administered by a pharmacist or other qualified staff; and
- Meet FDA’s Emergency Use Authorization criteria.
"No Wrong Door" policy for OHP coverage of COVID-19 vaccine administrations: OHA has also implemented a “No Wrong Door” policy to ensure access for both FFS and coordinated care organization (CCO) members who present themselves at any OHP-enrolled COVID-19 vaccine provider location for COVID-19 vaccinations.
- Providers contracted with the member’s CCO should bill the CCO.
- Providers not contracted with the CCO should bill OHA.
Be sure to also contact your local CCO(s) to explore direct contracting options. Find contact information at https://bit.ly/cco-contacts.
Eliminating barriers to care for people with disabilities: Disabilities may prevent patients from being able to comply with safety procedures such as face covering protocols, COVID-19 testing prior to surgical procedures, or going to health care appointments without a support person.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to OHP coverage of testing, screening, treatment and telemedicine services; OHP eligibility; and other information and resources related to providing and billing for covered services during COVID-19.
- The guide now contains a Health Equity section that includes the reasonable accommodations information listed above; as well as pharmacy point of sale billing instructions and OHA's "No Wrong Door" policy for COVID-19 vaccine administration.
Updates for all health care providers
Updated:
New:
Feb. 1, 2021 changes to the Prioritized List of Health Services
The interim modifications letter and all files for the Feb. 1, 2021 Prioritized List of Health Services are now available. The Feb. 1 changes incorporate:
- New billing codes, some of which are related to COVID-19.
- New HCPCS (procedure) codes, which were released too late to place on the Jan. 1, 2021 Prioritized List.
- Changes to practice guidelines and coding specifications associated with the new codes.
- Clarification of the intent to cover any new COVID-19 vaccine administration codes that may released prior to the next interim modification.
- Errata to previous lists.
For a full description of the Feb. 1 changes, please read the Health Evidence Review Commission's Notice of Interim Modifications.
Questions? Please email HERC.Info@dhsoha.state.or.us
Jan. 1, 2021 Covered and Non-Covered Dental Codes
The new interactive Covered and Non-Covered Dental Code list is now available for Jan. 1, 2021. Learn how to use the interactive list, and access the list.
- You can view 2020 and 2021 lists in the interactive format (just filter by "File Date" to view a specific year).
- You can also still view previous versions of the Covered and Non-Covered Dental Services list in Excel files on the OHP Dental Services policy page.
DRG Version 38 implementation planned for Feb. 21, 2021
OHA will update the Medicaid Management Information System (MMIS) with Version 38 of the Inpatient Diagnosis-Related Grouper effective Feb. 21, 2021.
Once OHA schedules reprocessing of inpatient claims for dates of service between 10/1/2020 and 2/21/2021, we will let you know.
Recent rule revisions
OAR 410-130-0245 - Removes Rule Language Regarding Blood Lead Screening That is Inaccurate and Conflicts with Other Rule
OAR 410-141-3830 - Updates to the Prioritized List of Covered Health Services
OAR 410-141-3860 - CCO Care Coordination Reporting Requirements
OARs 410-172-0690, 410-172-0720 - Clarify Adult Residential Prior Authorization Criteria and Admissions Procedures for Children’s Psychiatric Residential Treatment
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